Participants with features of central sensitisation have greater pain and disability at six months following musculoskeletal trauma: an exploratory study

Middlebrook, Nicola ORCID: https://orcid.org/0000-0003-2154-5723, Rushton, Alison, Abichandani, Deepa, Evans, David, Barbero, Marco, Heneghan, Nicola and Falla, Deborah (2021) Participants with features of central sensitisation have greater pain and disability at six months following musculoskeletal trauma: an exploratory study. In: Physiotherapy UK. (Unpublished)

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Abstract

PURPOSE: Following musculoskeletal trauma, a high proportion of people develop chronic pain, irrespective of the severity of injury. Central sensitisation (CS) characterised by features such as secondary hyperalgesia, tactile allodynia and widespread pain, could offer an explanation to the transition from acute to chronic pain. No study has evaluated early features of CS in this population. This exploratory study aimed to investigate features of CS, alongside other measures such as pain, quality of life and psychological features, soon after musculoskeletal trauma and explore whether these features are more evident in participants who develop greater pain and disability at six months. METHODS: 25 participants with lower limb fractures were recruited from a major trauma centre within two weeks of injury. To evaluate clinical features of CS, quantitative sensory testing (thermal and pressure pain thresholds and temporal summation) at sites local and remote to injury and pain drawings to quantify pain extent, were collected on two occasions, 48 hours apart. Other measures included the SF-36, EQ-5D-5L, pain intensity, Pain DETECT, the hospital anxiety and depression scale (HADS), Impact of Events Scale – Revised (IES-R) and sleep quality. The Chronic Pain Grade Scale (CPGS) was used to measure pain and disability at six months, with participants classified as low pain and disability (CPGS I) or high pain and disability (CPGS >II). RESULTS: 64% (n=16) of participants were classified as having high pain and disability at six months. Pressure pain thresholds (kPa) were lower at both local (average across sessions CPGS I 426.72 (176.80) CPGS >II 338.70 (175.64)) and remote sites (average across sessions CPGS I 485.64 (201.89), CPGS >II 397.13 (181.47)) with greater pain extent (average across all sessions CPGS I = 1.59%, CPGS >II = 7.06% ) suggestive of early features of CS in participants in CPGS >II group. Several other measures such as the HADS, IES-R, and pain DETECT were also higher in the CPGS > II group. CONCLUSION: Over 50% of participants following lower limb fractures irrespective of type of fracture or severity experience greater pain and disability at six months. Reduced pain thresholds and greater pain extent are suggestive of early features of CS in those experiencing greater pain and disability at six months. IMPACT: This study demonstrates the importance of psychophysical measures such as QST alongside other patient reported measures in the first step to understanding the transition from acute to chronic pain in this population. Future studies evaluating prognostic features influencing the transition from acute to chronic pain including psychophysical measures is now warranted.